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Impact of the acuit...
Impact of the acuity circle model for liver allocation on multivisceral transplant candidates
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- Ivanics, Tommy (author)
- Uppsala universitet,Gastrointestinalkirurgi,Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Michigan USA.
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- Vianna, Rodrigo (author)
- Division of Liver/GI Transplant Department of Surgery Miami Transplant InstituteJackson Memorial Hospital/University of Miami Miami Florida USA
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- Kubal, Chandrashekhar A. (author)
- Division of Abdominal Transplant Surgery Department of Surgery Indiana University School of Medicine Indianapolis Indiana USA
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- Iyer, Kishore R. (author)
- Recanati‐Miller Transplantation InstituteMount Sinai Hospital New York New York USA
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- Mazariegos, George V. (author)
- Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of Pittsburgh Pittsburgh Pennsylvania USA
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- Matsumoto, Cal S. (author)
- Medstar Georgetown University HospitalMedstar Georgetown Transplant Institute Washington DC USA
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- Mangus, Richard (author)
- Division of Abdominal Transplant Surgery Department of Surgery Indiana University School of Medicine Indianapolis Indiana USA
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- Beduschi, Thiago (author)
- Division of Transplantation and Hepatobiliary Surgery Department of Surgery University of Florida Gainesville Florida USA
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- Abouljoud, Marwan (author)
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Michigan USA
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- Fridell, Jonathan A. (author)
- Division of Abdominal Transplant Surgery Department of Surgery Indiana University School of Medicine Indianapolis Indiana USA
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- Nagai, Shunji (author)
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Michigan USA
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(creator_code:org_t)
- John Wiley & Sons, 2022
- 2022
- English.
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In: American Journal of Transplantation. - : John Wiley & Sons. - 1600-6135 .- 1600-6143. ; 22:2, s. 464-473
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Subject headings
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- Liver allocation was updated on February 4, 2020, replacing a Donor Service Area (DSA) with acuity circles (AC). The impact on waitlist outcomes for patients listed for combined liver-intestine transplantation (multivisceral transplantation [MVT]) remains unknown. The Organ Procurement and Transplantation Network/United Network for Organ Sharing database was used to identify all candidates listed for both liver and intestine between January 1, 2018 and March 5, 2021. Two eras were defined: pre-AC (2018–2020) and post-AC (2020–2021). Outcomes included 90-day waitlist mortality and transplant probability. A total of 127 adult and 104 pediatric MVT listings were identified. In adults, the 90-day waitlist mortality was not statistically significantly different, but transplant probability was lower post-AC. After risk-adjustment, post-AC was associated with a higher albeit not statistically significantly different mortality hazard (sub-distribution hazard ratio[sHR]: 8.45, 95% CI: 0.96–74.05; p = .054), but a significantly lower transplant probability (sHR: 0.33, 95% CI: 0.15–0.75; p = .008). For pediatric patients, waitlist mortality and transplant probability were similar between eras. The proportion of patients who underwent transplant with exception points was lower post-AC both in adult (44% to 9%; p = .04) and pediatric recipients (65% to 15%; p = .002). A lower transplant probability observed in adults listed for MVT may ultimately result in increased waitlist mortality. Efforts should be taken to ensure equitable organ allocation in this vulnerable patient population.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- clinical research
- practice
- health services and outcomes research
- intestine
- multivisceral transplantation
- liver transplantation
- hepatology
- organ allocation
- organ procurement and allocation
- organ procurement and transplantation network (OPTN)
- registry
- registry analysis
- united network for organ sharing (UNOS)
Publication and Content Type
- ref (subject category)
- art (subject category)
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To the university's database
- By the author/editor
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Ivanics, Tommy
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Vianna, Rodrigo
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Kubal, Chandrash ...
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Iyer, Kishore R.
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Mazariegos, Geor ...
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Matsumoto, Cal S ...
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show more...
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Mangus, Richard
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Beduschi, Thiago
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Abouljoud, Marwa ...
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Fridell, Jonatha ...
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Nagai, Shunji
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
- Articles in the publication
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American Journal ...
- By the university
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Uppsala University